The Value of Negative-Pressure Wound Therapy and Flap Surgery in Hidradenitis Suppurativa - A Single Center Analysis of Different Treatment Options.

Background: Hidradenitis suppurativa is manifested by painful abscesses and scarring of sweat glands. Axillary, inguinal and genital regions are mostly affected. Multiple options exist in the treatment of hidradenitis suppurativa. The aim of this retrospective, mono-center cohort study was to analyze the outcome of different treatment methods after radical excision of hidradenitis suppurativa. Methods: We retrospectively evaluated the treatment strategy and recurrence rate of hidradenitis suppurativa. We included all eligible patients of legal age between February 2003 and October 2021, with the diagnosis of Hidradenitis suppurativa and the necessity for surgical treatment. All patients with surgical treatment and direct wound closure by suture were excluded. Bacterial load and flora were analyzed for primary and secondary reconstruction in combination with negative-pressure wound therapy. Patient data were analyzed for recurrence rate and remission time according to different reconstructive techniques. Results: In 44 affected anatomical sites (n = 23 patients) we treated 15 patients with negative-pressure wound therapy. Bacterial load and flora were lower in the last wound swab of patients with multi-surgical procedures (22 localizations) compared to the first wound swab independent of the use of negative-pressure wound therapy.Wound closure, independent of a direct and multi-stage procedure was achieved by local fasciocutaneous flaps (n = 12), secondary intention healing (n = 7), secondary intention healing with buried chip skin grafts (n = 10), or split-thickness skin grafts (n = 15). Radical excision combined with split-thickness skin grafts showed the lowest recurrence rate in the follow-up (16%; n = 4). Conclusion: Radical excision of hidradenitis suppurativa as gold standard for surgical treatment combined with negative-pressure wound therapy as multi-stage procedures ultimately reduced bacterial load and flora in our study. The use of split-thickness skin grafts showed the lowest recurrence rate.

Secondary breast reconstruction after mastectomy using the DIEP flap.

INTRODUCTION: Breast reconstruction is an important element in the successful therapy of breast cancer [1]. Thereby, autologous microvascular breast reconstruction has been shown to be a reliable technique. The use of a deep inferior epigastric perforator (DIEP) flap or a muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flap is recognized in many centres as gold standard for reconstructive options [2-4]. Based on our experiences with 137 patients over a 5-year period we want to highlight the technical aspects of the free microsurgical autologous breast reconstruction using a DIEP flap. PATIENTS AND METHODS: Between 01/2013 and 12/2017 we treated 137 patients (age 32-78 years, mean age 52 years) after mastectomy with autologous microsurgical free flap breast reconstruction. A DIEP flap was used for breast reconstruction in 33 patients. In 104 cases, we performed a muscle sparing TRAM flap. In this video we demonstrate the typical sequence of operative steps of a DIEP flap in a 32 year old patient after mastectomy due to an invasive ductal breast carcinoma. RESULTS: The rate of total flap loss in our department was 2.2% including all patients. In less than 1%, partial flap necrosis could be observed. 61% of the patients had undergone previous irradiation. Within the small number of flap loss, we could not observe a trend towards a correlation between flap loss and previous irradiation. CONCLUSION: Autologous breast reconstruction using a DIEP or MS-TRAM flap provides a surgically safe technique including a low incidence of flap loss in specialized centres.

[Palmar dislocation of the proximal interphalangeal joint and traumatic boutonnière deformity]. / Palmare Luxation im proximalen Interphalangealgelenk und traumatische Knopflochdeformität.

Injury to the central slip of the extensor tendon may occur with open and also with closed injuries, such as volar dislocation of the proximal interphalangeal (PIP) joint. For adequate treatment, it is necessary to identify all injured structures. Without appropriate primary management, the patient is likely to develop a subacute to chronic posttraumatic boutonnière deformity. A fixed boutonnière deformity requires recovery of joint mobility. Once joint mobility is achieved, secondary surgical reconstruction of the central slip can be performed with a tendon transfer or a tendon transplant.

2,5-Dimethyl-4-hydroxy-3(2H)-furanone as a secondary metabolite from D-fructose-1,6-diphosphate metabolism by Zygosaccharomyces rouxii.

2,5-Dimethyl-4-hydroxy-3(2H)-furanone (DMHF) is an important aroma compound found in many fruits such as strawberries and pineapples and it is also produced by the soy-sauce-fermenting yeast Zygosaccharomyces rouxii after the addition of d-fructose-1,6-diphosphate to yeast-peptone-dextrose nutrient media. Dilute DMHF solutions exhibit a strawberry-like flavor while DMHF concentrates have a caramel-like aroma. In media containing D-fructose-1,6-diphosphate as the sole carbon source, growth of Z. rouxii and formation of DMHF were not observed. Although Z. rouxii cells grew in media with D-glucose as the sole carbon source, DMHF was only produced when media were supplemented with D-fructose-1,6-diphosphate. The DMHF concentration always correlated with the yeast cell count and D-fructose-1,6-diphosphate concentration. Addition of CaCl2 (up to 50 g.l(-1)) led to a higher DMHF concentration. Addition of Na2SO3 reduced the growth of Z. rouxii and inhibited DMHF formation. The amount of DMHF formed by Z. rouxii was not significantly affected by the addition of KH2PO4. DMHF concentrations of 5 and 10 g.l(-1) partially and completely inhibited the growth of Z. rouxii cells, respectively. Only the singly labeled furanone was formed after the addition of 1-13C-D-fructose-1,6-diphosphate to the medium. However, unlabeled DMHF was formed in the presence of (13)C(6)-D-glucose. Therefore, the carbons of the furanone originate exclusively from exogenously supplied D-fructose-1,6-diphosphate as no exchange with the internal pool of D-fructose-1,6-diphosphate occurs. This implies that DMHF is a secondary metabolite of Z. rouxii formed from D-fructose-1,6-diphosphate. We assume that at least the first step of the metabolism of D-fructose-1,6-diphosphate takes place in the cell wall or membrane of the yeast.

Metabolism of ethyl tiglate in apple fruits leads to the formation of small amounts of (R)-ethyl 2-methylbutanoate.

(S)-Ethyl 2-methylbutanoate is an important aroma compound in apples and serves as an indicator for genuineness of apple products due to its high optical purity of greater than 98% enantiomeric excess [T. Koenig and P. Schreier, Zeitsch. Lebensm.-Unters. Forsch. A, 1999, 208, 130-133; K. Schumacher et al., J. Agric. Food Chem., 1998, 46, 4496-4500]. The origin of minor amounts of (R)-ethyl 2-methylbutanoate is unknown as naturally occurring (+)-isoleucine, the proposed precursor of (S)-ethyl 2-methylbutanoate is enantiomerically pure. Since ethyl (E)-2-methyl-2-butenoate (ethyl tiglate) was recently discovered as a natural apple constituent and hydrogenation activity in apples was demonstrated we proposed ethyl tiglate as a precursor of (R)-ethyl 2-methylbutanoate. D4-3,4,4,4-ethyl tiglate was synthesized and was injected into ripe apple fruits (cv. Golden Delicious, Red Delicious and Granny Smith). After 3, 6, and 12 days apple volatiles were isolated by solid phase extraction on XAD-2 and the metabolites formed from D4-3,4,4,4-ethyl tiglate were analyzed by capillary gas chromatography-mass spectrometry (GC-MS). Ethyl 2-methylbutanoate, 2-methylbutyl acetate, 2-methylbutanol, and 2-methylbutanoic acid were identified as major transformation products. Chiral evaluation of the metabolites by multidimensional GC-MS revealed enantiomeric excesses ranging from 43% (S) to 30% (R) depending on the apple cultivar, sampling date and metabolite. The data show for the first time that the natural apple constituent ethyl tiglate can serve as a source for (R)-2-methylbutanol derivatives.

Development of a monoclonal antibody for ELISA of CYP1A in primary cultures of rainbow trout Oncorhynchus mykiss hepatocytes.

Induction of cytochrome P4501A CYP1A in cultured cells can be used to determine the induction potencies of xenobiotics or complex environmental samples. This report describes the development of an enzyme linked immunosorbent assay ELISA for measurement of CYP1A expression in primary cultures of rainbow trout Oncorhynchus mykiss hepatocytes. Juvenile rainbow trout were injected with naphthoflavone BNF 25 mg kg-1 body weight to induce the synthesis of CYP1A. The CYP1A isoenzyme was purified, characterized by immunological cross reactivity and N terminal sequencing and used to prepare a monoclonal antibody in Balb C mice. The specificity of the antibody for CYP1A was proved by Western blotting of samples from control and BNF injected fish. Two ELISA methods, a direct and a competitive one, were evaluated, with both methods being of comparable sensitivity. Rainbow trout hepatocytes, maintained as monolayers in serum free, chemically defined medium, were exposed to naphthoflavone, and the induction response was measured both by 7 ethoxyresorufin O deethylase EROD activity and the direct ELISA method. Comparison between EROD activity and immunodetectable CYP1A protein can provide information on the catalytic efficiency of CYP1A.